Aerosol Therapy and Nebulizers RET 2274 Respiratory Therapy Theory Lab I Module 6.1.
Respiratory Module
description
Transcript of Respiratory Module
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Respiratory Module
C.O.P.D.
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COPD - overview
COPD?– Chronic Obstructive Pulmonary Disease
• COLD?– Chronic Obstructive Lung Disease
• Broad classifications of disease
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COPD
• Characterized by – airflow limitation – Irreversible– Dyspnea on exertion– Progressive– Abn. inflammatory response of the lungs to
noxious particles or gases
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Pathophysiology
• Noxious particles of gas • Inflammatory response – (occurs throughout the airways, parenchyma and
pulmonary vasculature)
• Narrowing of airway
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Pathophysiology
• Injury Repair• Injury repair• Injury repair• Injury Repair• Injury repair scar tissue – Narrowing of lumen
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Pathophysiology
• Inflammation • Thickening of the wall of the pulmonary
capillaries• (Smoke damage & inflammatory process)
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COPD
• Includes– Emphysema– Chronic bronchitis
• Does not include– Bronchiectasis– Asthma
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COPD - FYI
• COPD 4th leading cause of death in the US• 12th leading cause of disability• Death from COPD is on the rise while death
from heart disease is going down
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COPD
Risk Factors for COPD• Exposure to tobacco smoke – 80-90% of COPD
• Passive smoking• Occupational exposure• Air pollution
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COPD risk factors
• #1– Smoking
• Why is smoking so bad??– ↓ scavenger cell ability– ↓ cilia function– Irritates goblet cells & Mucus glands • ↑ mucus production
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Chronic Bronchitis
• Disease of the airway• Definition:– cough + sputum production – > 3 months – 2 consecutive years
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Chronic Bronchitis
Pathophysiology• Pollutant irritates airway • Inflammation + secretion of mucus • goblet cells +• mucus secreting glands + Mucus• ciliary function
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Chronic Bronchitis
• Plugs become areas for bacteria to grow and chronic infections which increases mucus secretions and eventually, areas of focal necrosis and fibrosis
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Chronic Bronchitis
• Bronchial walls thicken– Bronchial Lumen narrows– Mucus plugs airway
• Alveoli/bronchioles become damaged• ↑ alveolar macrophages • ↑ susceptibility to LRI
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What do you think?
Exacerbation of Chronic bronchitis is most likely to occur during?
A.Fall B.SpringC.SummerD.Winter
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Emphysema
Pathophysiology• Affects alveolar membrane– Destruction of alveolar wall– Loss of elastic recoil– Over distended alveoli
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Emphysema
Pathophysiology• Over distended alveoli– Damage to adjacent pulmonary capillaries– dead space– Impaired passive expiration
• Impaired gas exchange
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Emphysema
• Impaired gas exchange– impaired expiration• Hypoxemia• CO2 • Hypercapnia• Respiratory acidosis
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Emphysema
• Damaged pulmonary capillary bed– pulmonary pressure – work load for right ventricle – Right side heart failure (due to respiratory
pressure) – Cor Pulmonale
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COPD Compare and contrast
• Chronic Bronchitis is a disease of the ___________?– Airway
• Emphysema is a disease affecting the ___________?– Alveoli
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C.O.P.D.
• Risk factors, S&S, treatment, Dx, Rx - same for Chronic Bronchitis & Emphysema
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C.O.P.D.
Clinical Manifestation (primary)
1. Cough2. Sputum production3. Dyspnea on exertion(Secondary)• Wt. loss• Resp. infections• Barrel chest
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C.O.P.D.Nrs. Assessment
• Risk factors• Past Hx / Family Hx• Pattern of development• Presence of comobidities• Current Tx• Impact
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C.O.P.D. Diagnostic exams/procedures
• Pulmonary function test– Tidal Volume•
– Functional residual•
– Spirometry / FEV (force of expired vol.)•
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C.O.P.D. Diagnostic exams/procedures
• Bronchodilator reversibility test– Check FEV – Give Bronchodilator– If improved FEV = Asthma– If no improvement FEV = COPD
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• ABG’s– Baseline PaO2
• Rule out other diseases– CT scan– X-ray
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C.O.P.D. Medical Management
• Risk reduction– Smoking cessation!• (The only thing that slows down the progression of the
disease!)
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C.O.P.D. Rx. therapy
Primary• Bronchodilators• CorticosteriodsSecondary• Antibiotics• Mucolytic agents• Anti-tussive agents
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Bronchodilators• Action:– Relieve bronchospasms– Reduce airway obstruction–↑ ventilation
• Route– Metered-dose inhaler– Nedulizer– Oral
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Bronchodilators• Frequency– Regularly throughout the day– & PRN– Prophylactically
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Bronchodilators
• Examples– Albuterol (Proventil, Ventolin, Volmax)– Metaproterenol (Alupent)– Ipratropium bromide (Atrovent)– Theophylline (Theo-Dur)*
* Oral
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Glucocorticoids
• Action– Potent anti-inflammatory agent
• Route– Inhaled– Systemic • (oral or intravenous)
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Endocrine FlashbackWhich of the following is an iatrogenic event
secondary to prolonged use of corticosteroid medications?
A.SIADHB.Diabetes InsipidusC.Cushing diseaseD.Addison’s diseaseE.Acromegaly
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What electrolyte imbalance is assoc with Cushing Syndrome?
A. HypercalcemiaB. HypocalcemiaC. HypernatremiaD. HyponatremiaE. HyperkalemiaF. Hypokalemia
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Corticsteriods
• S/E– Cushing• Moon face• Na+ & H20 retention
– Never discontinue abruptly
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• What affect do corticosteroids have of blood sugar levels?
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Glucocorticoids
• Examples– Prednisone– Methyprednisone– Beclovent
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C.O.P.D. Medical Management
• Treatment– O2• When PaO2 < 60 mm Hg
– Pulmonary rehab• Breathing exercises• Pulmonary hygiene
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Nursing Management
• Impaired gas exchange• Ineffective airway clearance• Ineffective breathing patterns• Activity intolerance• Deficient knowledge about self-care• Ineffective coping
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Nursing Management
• Impaired gas exchange– Bronchodilators– Corticosteroids– Monitor for side effects– Measure FEV (force of expired volume)– Assess dyspnea– Smoking cessation
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Nursing Management
• Ineffective airway clearance– Eliminate pulmonary irritants– Directed cough– Chest physiotherapy– Fluids– Aerosol mists
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Nursing Management
• Ineffective breathing patterns– Teach and encourage breathing exercises…
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Nursing Management• Breathing exercises
– (usually have shallow, rapid, inefficient breathing)
– Diaphragmatic breathing • ↓rate• ↑ventilation• ↑expelled air
– Pursed lip breathing• Slows respiration• Prevents collapse of small airways• Helps control rate and depth• Relax (↓ anxiety)
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Nursing Management• Activity intolerance– Activity pacing
• More fatigued in AM• Plan activities for “best times”
– Physical conditioning• Exercise training
– ↑tolerance– ↓dyspnea– ↓fatigue
• Graded exercise• Regular vs. sporadic
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Nursing Management
• Deficient knowledge about self-care– ↑participation (ĉ ↑ improvement)– Coordinate diaphragmatic breathing with
activities– Avoid fatigue– Fluids always available
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Knowledge Deficit
• O2 therapy– Flow rate– # hours required– No smoking– Regular blood oxygenation levels– Regular ABG’s
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Knowledge Deficit
• Set realistic goals• Modify life style• Avoid temperature extremes– Heat • ↑ O2 demand
– Cold • ↑ bronchospasms
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Nursing Management
• Ineffective coping– Set realistic goals– Listen– Empathy– Refer
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C.O.P.D.Nursing Management
• Imbalanced Nutrition: Less than Body requirement– (frequently weight loss and protein breakdown)– Monitor weight– ↑Protein – Nutritional supplements
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Question?A patient is getting discharged from a SNF facility. The patient has a history
of severe COPD and PVD. The patient is primarily concerned about their ability to breath easily. Which of the following would be the best instruction for this patient?
A. Deep breathing techniques to increase O2 levels. B. Cough regularly and deeply to clear airway passages. C. Cough following bronchodilator utilization D. Decrease CO2 levels by increase oxygen tank output during meals.
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Bronchiectasis
Pathophysiology• Chronic, irreversible, dilation of the bronchi and
bronchioles• Inflammatory process • Damage of bronchial wall • Permanently distended
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Bronchiectasis
• Pathophysiology– Form sacs – Secretion pool – Infections
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Bronchiectasis Etiology
• 2nd chronic disorder• Pulmonary infection• Aspiration• Bronchus obstruction• Genetic disorder– Cystic fibrosis
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Bronchiectasis
Clinical Manifestations• Recurrent LRI• Cough• Sputum
– Copious (>200ml)– Purulent– Foul smelling
• Auscultation– Wheezes– Crackles
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Bronchiectasis
• If wide spread – Dyspnea
• Clubbing of the fingers
• pulmonary blood pressure Cor pulmonale
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Bronchiectasis
Dx• S&S• Sputum cultures– r/o TB
• CT*
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Bronchiectasis
Tx• Bronchodilators• Mucolytic agents• Antibiotics• Surgery• O2– If hypoxemia
• Postural drainage• Chest physiotherapy• Smoking cessation
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Asthma Pathophysiology
• Characterized by intermittent airway obstruction
• In response to variety of stimuli – Epithelial lining of the airway respond by
becoming inflamed and edematous– Bronchospasms– Secretions increase in viscosity
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Asthma
Pathophysiology• The airway hyper-responsiveness, mucosal edema &
mucus production leads to• Recurrent episodes of symptoms– Cough– Chest tightness– Wheezing– dyspnea
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Asthma
What is the strongest predisposing factor for asthma?
A. SmokingB. Family historyC. AllergyD. Having a weird middle name
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AsthmaPathophysiology
• Mast-cells play a key role in the inflammatory process
• Alpha– adrenergic receptors trigger broncho-constriction
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What is the action of a mast-cell stabilizer
A. Reduces histamine releaseB. Increases the effectiveness of the white
blood cellsC. Increase WBC productionD. Bronchodilatation
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Thought question?
Why is Asthma not considered a form of C.O.P.D?
A. Smoking is not a risk factorB. It is not irreversibleC. It doesn’t start with the letter “C”D. It is not a chronic diseaseE. It is not an obstructive disease
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AsthmaS&S
Primary• Cough• Dyspnea• Wheezing– Expiratory– Nasal flaring
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Asthma
Assessment & Dx• History• Co-mobid conditions– Gastro-esophageal reflux
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Asthma
During an Acute episode• Respiratory rate– Increased (initially)
• CO2?– Decreased – Resp. alkalosis
– Tired – Decreased Resp. rate
• CO2 ? – Increased – Resp acidosis
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Asthma
• O2 Sats?– Decreased– Cyanosis
• Heart rate– Increased
• Blood Pressure– Increased
• Anxious, feeling of impending doom!
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AsthmaPrevention
• Manipulate known triggers– Stress– Pollen
• Exercise
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AsthmaRx therapy
2 general classes of asthma medications1. Quick-relief 2. Long-acting• Because of the underlying pathology of asthma is
inflammation, controlled primarily with anti-inflammatory meds
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AsthmaRx therapy
• Bronchodilators– Aminophylline
• Anticholinergics– Atropine Sulfate– Atrovent
• Corticosteriods– Prednisone– Decreased inflammation
• Mucolytic agents– Acetylcysteine
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Asthma
• Diet– Fluids
• Activity– Rest periods– Relaxation techniques– Not overexert self– Sit down and sip warm water
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Status Asthmaticus
• Pathophysiology– Attack lasting > 24 hours– Do not respond to normal treatment
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• The term “pink puffer” refers to the client with which of the following conditions?A. ARDSB. AsthmaC. Chronic obstructive bronchitisD. Emphysema
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A 66 year old client has marked dyspnea at rest, is thin and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which disease?
A. AsthmaB. Chronic BronchitisC. Emphysema
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• It’s highly recommended that clients with asthma, chronic bronchitis and emphysema have Pneumovax and flu vaccinations for which of the following reasons?
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A. All clients are recommended to have these vaccinesB. These vaccines produce bronchodilation and
improve oxygenationC. These vaccines can reduce tachypnea D. Respiratory infections can cause severe hypoxia and
possible death in these clients
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Exercise has which of the following effects on clients with asthma,
chronic bronchitis and emphysema?
A. It enhances cardiovascular fitnessB. It improves respiratory muscle strengthC. It reduces the number of acute attacksD. It worsens respiratory function and is
discouraged
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Clients with Chronic Obstructive Bronchitis are given diuretics. Which of the following
best explains why?
A. Reducing fluid volume reduces oxygen demandB. Reducing fluid volume improves the clients mobilityC. Reducing fluid volume reduces sputum productionD. Reducing fluid volume improves respiratory function